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OW'NERADDRESS CITY/STATE/ZIP <br /> ' CONTRACTOR t/Vl 1 k C i l0 scL' 4--c- fie_ PHONE K S(,r, <br /> CONTRACTOR ADDRESS ` O CITY/STATE/ZIP ' C <br /> ' LICENSE ❑C-42 ❑C-36 OTHER NUMBER �q EXPIRATION DATE <br /> WATER TABLE DEPTH:_ II CEOGRAPHR AL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # _ 1 BUILDING PERMIT# LAND USE APPLICATION# 1 <br /> —� <br /> TYPE OF WORK: NEW INSTALLATION ❑ REPAIR/ADDITION ❑ ENGINEER DESIGNED/ALTERNATIVE <br /> ❑ REPLACEMENT �.� ❑ DESTRUCTION <br /> INSTALLATION WILL SERVE: Els!RESIDENCE COMMERCIAL ❑ OTHER <br /> �,/'NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: NUMBER OF EMPLOYEES: <br /> {d SEPTIC TANK TYPFIMFG #0 v CAPACITY Z'p sb gal #OFCOMPARTMENTS� <br /> ❑ GREASE TRAP TYPE/MFG_ CAPACITY gal #OF COMPARTMENTS <br /> ❑ PKGTXPLANT DISTANCE.TO NEAREST: <br /> �NIAWELL --�� It FOUNDATION fOT A PROPERTY LINE 10t B <br /> LIFT STATION SIzE�T11_''TYP OFP""d UMP niZ'ENGD ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ' ❑ LEACH LINES ❑ LEACHING CHAMBERS #OF LINES LENGTH OF LINES B <br /> DISTANCE TO NEAREST WELL I Il FOUNDATION ____ fl PROPERTY LITE R <br /> R' FILTER BED WIDTH xy t R H LENGTH � R DEPTH ( p p- H <br /> ' DISTANCE TO NEAREST WELL I OZ) +- R FOUNDATION ft PROPERTY LINE /pl R <br /> ❑ MOUNDED WIDTH fl LENGTH A DEPTH fl <br /> ' DISTANCE TO NEAREST WELL R FOUNDATION Il PROPERTY LINE fl <br /> ❑ SUMPS WIDTH R LENGTH R DEPTH It <br /> DISTANCE TO NEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ' ❑ DISPOSAL PONDS WIDTH R LENGTH _ft DEPTH B <br /> DISTANCE TO NEAREST WELL Il FOUNDATION fl PROPFRIYLINF. ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH R DEPTH R <br /> DISTANCE.TO NEAREST WELL H FOUNDATION Il PROPERTY LINE ft <br /> I HEREBYCERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY <br /> ORDINANCES,STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> NI(NIMOM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS PITASE CALI.(209)95;.7697 <br /> ' SIGNED `'A TITLE �dyt �.CaGI��r DATE <br /> C <br /> 100% 5EINAGE ViSP05A6-1 ~~ <br /> TALL EXPANSION AREA <br /> ' (E) W-O" CHAIN RICADE F IL R BE <br /> LINK PENCE RAIL RO D TIES OR Q <br /> EPHONE E5 <br /> =56:2.00' <br /> ' � 7 <br /> G t INTER- — <br /> ' PAVI G STONE ® Q Y r <br /> LK L— ____—_—__, —_----___---l=0 -o _D <br /> 47 <br /> I .. <br /> 2,000 GAL SAND/OIL <br /> Nil 2-2-,307 <br /> 5EP TOR _ _..�. l.. ® Ip1 O M UNN <br /> Cn17 <br /> - o0o TWENT <br /> f <br /> DF.PARTMENI SE( LI <br /> Application Aceted C Dete -%� Area Employee ID# <br /> \ <br /> Final Inspection II.-.- i '7 Dale _ ,_. _._. ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil NI.Depth of 3 t: Pit/Sump Soil Charieter: <br /> COMMENTS PA&LcS / U <br />